José Mario López Saca is a Specialist in Internal Medicine and Palliative Care, Hospital Dr Juan José Fernández, Zacamil, San Salvador, El Salvador and collaborator with the ATLANTES Research Programme of the Institute for Culture and Society, University of Navarra (Spain). Here, he addresses some of the concerns about the possible effects of morphine. His longer article is published in the November/December issue of the European Journal of Palliative Care.

We included all studies on the topic from 15 years back, observing that when opioids had been used in standard doses, either to relieve pain or dyspnoea, life had never been shortened, nor had respiratory depression occurred.

The most relevant studies that respond to these questions are those that include a bigger sample of patients. For example, a cohort study on survival and opioids 1 shows that opioid doses in end of life patients is a factor that does little to explain survival variation (6%), as it is associated with complex factors that are difficult to measure. This reason justifies morphine being used with no fear of shortening life. Paradoxically, in other studies 2 it is observed that the higher the morphine doses, the longer the patients live.

The studies on respiratory arrest and use of opioids in end of life care patients allow us to conclude that using morphine to relieve dyspnoea never puts the patient at risk. Morphine makes breathing deeper and slower, allowing a bigger time for gas exchange, improves the self-rated dyspnoea of the patient in a numeric scale (NRS), and leads also to an increase in oxygen saturation due to the respiratory frequency decrease. Furthermore, morphine, together with the oxygen therapy, reduces the anxiety that causes a choking sensation.

This post highlights some of the findings of two of the systematic reviews carried out by our team 3,4 that are summarised in our article published in this month’s European Journal of Palliative Care. In summary, having reviewed the literature we can certainly see stated in many studies that opioids are safe, do not compromise life, and essentially that they relieve pain and dyspnoea. So no more doubts!

Besides, more evidence is appearing on the survival issue: Minami et al. in 2014, 5 demonstrates once again that opioids do not shorten survival, and Boland et al. conclude the same with a new systematic revision. 6

Physicians can be certain that when prescribing morphine in standard doses, we are relieving the symptoms of patients with advanced illness. The evidence has dispelled the myth that opioids shorten life or produce respiratory arrest.

Read the full article in the European Journal of Palliative Care

This post relates to a longer article, ‘Reaffirming the benefits of morphine to beat opiophobia’ by Mario López Saca and Carlos Centeno, published in the November/December 2015 issue of the European Journal of Palliative Care(vol. 22.6).

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